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The HIV/AIDS Pandemic among Youth in Sub-Saharan Africa
HIV/AIDS seriously affects adolescents throughout the world. One-third
of all currently infected individuals are youth, ages 15 to 24, and half
of all new infections occur in youth the same age.1 More than five young
people acquire HIV infection every minute; over 7,000, each day; and more
than 2.6 million each year.1
About 1.7 million new adolescent HIV infections—over half of the
world's total—occur in sub-Saharan Africa.1 In fact, nearly 70 percent
of people living with HIV/AIDS live in sub-Saharan Africa, and over 80
percent of AIDS deaths have occurred there.2,3
Although HIV/AIDS rates vary considerably throughout sub-Saharan Africa—generally
lower in western Africa and higher in southern Africa—the epidemic
has had a devastating effect on most African youth who often lack access
to sexual health information and services. In particular, unmarried youth
have great difficulty getting needed sexual health services. At the same
time, cultural, social, and economic norms and pressures often put young
African women at excess risk for HIV infection.
Leaders of some African nations, once unable to acknowledge the presence
of HIV/AIDS, now publicly address HIV prevention and appoint task forces
to mobilize and coordinate efforts against the epidemic.3 In addition,
business coalitions and non-governmental organizations
(NGO's) often lead in utilizing peer education, advocacy, youth-friendly
service delivery, and social marketing to battle HIV infection in sub-Saharan
African nations.4 Some NGO's encourage youth to get involved in finding
and implementing ways to stop the spread of HIV.
AFRICAN YOUTH FACE FAST GROWING RATES OF INFECTION WITH HIV AND
OTHER STDS.
· Experts estimate that half a million African youth, ages 15 to
24, will die from AIDS by the year 2005.5 In African countries with long,
severe epidemics, half of all infected people acquire HIV before their
25th birthday and die by the time they turn 35.6
· The epidemic means that African youth face a bleak future. In
1997 in Zimbabwe, half of all 15-year-old males could expect to die before
age 50 compared to 15 percent in 1983. Between 1983 and 1997, 15-year-old
females' risk of death prior to age 40 quadrupled from 11 to over 40 percent.6
· Infection with a sexually transmitted disease (STD), especially
one that causes genital ulcers, such as herpes or syphilis, puts one at
increased risk for HIV infection, and sexually active youth in sub-Saharan
Africa are at high risk for STD infection.7 For example, 10 to 20 percent
of the sexually active population of sub-Saharan Africa is infected with
gonorrhea.5
· Half of all HIV infections worldwide occur in women in Africa.2
· In seven of 11 studies in Africa, at least one woman in five,
ages 20 to 25, was HIV infected; most HIV-infected young women will not
live to age 30.6 In one city in South Africa, six out of 10 women, ages
20 to 25, were HIV infected; among youth in their early 20's, women's
rates were three times higher than men's.6 In Malawi, HIV incidence in
teenage women is six percent compared to less than one percent in women
over age 35.1
· Throughout sub-Saharan Africa, HIV infection rates among teenage
women are over five times higher than rates for teenage males. In Kenya,
nearly one teenage woman in four is living with HIV, compared to one teenage
male in 25.1
· The physical immaturity of younger
women and women's lower status in society may contribute to disproportionate
HIV infection rates. Women's lower status may prevent them from having
control of their sexual relationships. For example, studies on women's
first sexual experience show that over half of young women in Malawi and
over 20 percent of young women in Nigeria experienced forced sexual intercourse.6,7
INADEQUATE SEXUAL HEALTH INFORMATION AND LIMITED ACCESS TO HEALTH
CARE ARE OBSTACLES TO LOWERING ADOLESCENT HIV/STD INFECTION RATES.
· African adolescents cite lack of knowledge, inaccessibility,
and safety concerns as primary reasons for not using contraception. For
example, one study showed that less than 50 percent of youth in Madagascar
and Nigeria know about contraception. Limited resources also make contraceptive
use lower in Africa than in other world regions.5
· Many African health services workers feel it is inappropriate
to provide contraceptives to adolescents, often making it difficult or
impossible for youth to obtain condoms and other contraception.8 For example,
a study in Kenya found that three-fourths of family planning workers were
unwilling to provide contraceptives to young women who had not given birth.8
· In sub-Saharan Africa, only half
of the population has easy access to health care. Africa has one-third
as many nurses per capita as the rest of the world. Moreover, the current
ratio of doctors is lower than one per 10,000 population; the world average
is one per 800.8 Limited budgets, problems imposed by the HIV epidemic,
and few health care providers mean that improving reproductive health
services is a challenge for most sub-Saharan African countries.8
SEXUAL HEALTH ATTITUDES AND BEHAVIORS GREATLY AFFECT ADOLESCENTS'
RISK OF INFECTION.
· In sub-Saharan Africa, as in other regions of the world,
a culture of silence surrounds most reproductive health issues. Many adults
are uncomfortable talking about sexuality with their children. Others
lack accurate sexual health knowledge.5
· Many Africans feel unable to discuss sexuality across perceived
barriers of gender and age differences.3 Many Africans are also reluctant
to provide sexually active adolescents with condoms.3
· In several African countries, some people believe that men are
biologically programmed to need sexual intercourse with more than one
woman. Polygamy is a central, social institution that reinforces this
belief. Moreover, some men believe that this "biologically programmed
need" makes high-risk sex unavoidable.3
· In some impoverished communities,
high HIV infection rates may be partly explained by early sexual initiation,
consensual or coerced. For example, in a survey of 1,600 urban Zambian
youth, over 25 percent of 10-year-old children and 60 percent of 14-year-old
youth reported already having sexual intercourse.6
· One study of adolescents in 17 African countries showed that
those with more education were far more likely to experience casual sex
and to use condoms for casual sex when compared to less educated youth.6
CULTURAL, SOCIAL, AND ECONOMIC FACTORS ALSO FUEL THE HIV EPIDEMIC.
· Some faith traditions in Africa teach that AIDS is a shameful
disease and a punishment for those who have been sexually promiscuous,
and many adults are reluctant to admit to a disease that seems to imply
promiscuity.3 One study showed three quarters of Nigerian Christian leaders
believe that AIDS is a divine punishment.3
· Poverty and HIV transmission are linked in a variety of ways.
Poverty often leads to prostitution or to trading sexual favors for material
goods. Young women may be especially vulnerable due to societal practices
that deny them education and work opportunities. Poverty also leads to
poor nutrition and a weakened immune system, making poor people more susceptible
to tuberculosis and to STDs.2,6,8
· The costs of providing treatment for people with AIDS drains
resources from education, agriculture, and other domains important to
gross national product. By 2005, AIDS treatment costs are expected to
account for more than one third of Ethiopia's government health spending,
more than half of Kenya's, and nearly two-thirds of Zimbabwe's.9
· In sub-Saharan Africa nearly eight million children, ages 14
and under, had been orphaned by AIDS by the end of 1997. Many of these
youth must drop out of school.1,6
References:
1. UNAIDS. Listen, Learn, Live! World AIDS Campaign with Children and
Young People: Facts and Figures. Geneva: UNAIDS, 1999.
2. Akukwe C. HIV/AIDS in African children: a major calamity that deserves
urgent global action. J HIV/AIDS Prev Educ for Adolesc & Children
1999; 3(3):5-24.
3. Caldwell JC. Rethinking the African AIDS epidemic. Popul Develop Review
2000; 16:117-135.
4. Population Reference Bureau [and] Population Services International.
Social Marketing for Adolescent Sexual Health: Results of Operations Research
Projects in Botswana, Cameroon, Guinea, and South Africa. Washington,
DC: The Bureau, 2000.
5. Pathfinder International, Africa Regional Office. Adolescent Reproductive
Health in Africa: Paths into the Next Century. Nairobi, Kenya: The Office,
1999.
6. UNAIDS. Report on the Global HIV/AIDS Epidemic. Geneva: UNAIDS, 2000.
7. UNAIDS. Force for Change: World AIDS Campaign with Young People: 1998
World AIDS Campaign Briefing Paper. Geneva: UNAIDS, 1998.
8. Rosen JE, Conly SR. Africa's Population Challenge: Accelerating Progress
in Reproductive Health. [Country Study Series, no. 4] Washington, DC:
Population Action International, 1998.
9. UNAIDS. The UNAIDS Report. Geneva: UNAIDS, 1999.
Written by Tawa Jogunosimi
February 2001 © Advocates for Youth
Click here to view the Publications Catalog and/or to order this publication.
The latest statistics on the world epidemic of AIDS & HIV, were published
by UNAIDS in July 2004. The report gives the latest AIDS and HIV statistics
from around the world as well as the statistics for individual countries.
1
World Estimates of the HIV/AIDS Epidemic
at the end of 2003
Total number of AIDS deaths between 1981 and the end of 2003. 20 million
Total number of children orphaned by AIDS in Sub-Saharan Africa between
1981 and the end of 2003. 12 million
By December 2003 women accounted for nearly 50% of all people living with
HIV worldwide, and for 57% in sub-Saharan Africa.
Young people (15-24 years old) account for half of all new HIV infections
worldwide, more than 6000 become infected with HIV every day.
An estimated five million people in low and middle income countries do
not have the AIDS drugs which could save their lives.
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